I hope this title caught your attention.I am writing this article on the night I was told my brother, only five
years my senior, had a massive stroke (April 16, 1995).One of the main contributing factors of his stroke may have been what I
want to discuss in this article.

For
over 20 years I have been studying and researching the reasons for the collapse
of the oral cavity and the airway.I
have combined that information with the materials I have received from the
physicians who specialize in sleep, and now work in co-operation with them, in
the treatment of snoring and sleep apnea.

What
is so serious about snoring and sleep apnea?

If
you snore loudly and often, you may be accustomed to elbow thrusts in the middle
of the night and a lot of bad jokes.But
snoring is no laughing matter.It
is a signal that something is wrong with breathing during sleep.It means that the airway is not fully open.The “log sawing” noises come from efforts to force air through
narrowed passageways.

Perhaps
4 in every 10 adults snore and for most, snoring has no serious medical
consequences.However for some,
habitual snoring is the first indication of a potentially life threatening
disorder called “Obstructive Sleep Apnea (OSA)”.

Sleep
apnea is a multi-factorial sleep disorder that is gaining greater recognition
among physicians and the lay public.It
has recently had much coverage in the news media.

What
is Sleep Apnea?

Obstructive
sleep apnea is the stoppage of airflow for at least 10 seconds because of an
upper airway obstruction in the presence of a respiratory effort.The respiratory effort continues despite the obstruction until the
individual is aroused from sleep.Many
times the end of an apnea event ends in a “snort”.The individual, although aroused, may not be aware of awakening - and
that is why he/she has some of the symptoms I will discuss later.The severity of the apnea is usually categorized by the frequency of the
episodes.Under 5 blockages
or “episodes” per hour is considered normal.More than 20 apnea episodes per hour of sleep can increase the risk of a
heart attack 23 times!In my
brother’s case, it increased his blood pressure, which caused the stroke.Duration, or length of the blockage is also a significant factor.Blockages can last from 10 to 120 seconds and in very severe cases,
longer than that.As you are
reading this, some of you are thinking that your spouse or someone else you know
may be suffering from just what I am discussing.That is why I am writing this article.

During
sleep, muscles in the throat and neck relax much more than they do during waking
hours.In most people this normal
process causes no problems; sleep is a time of rest.However, for some people muscles relax excessively, compromising
breathing and making sleep a time of danger.A collapse of the airway walls blocks breathing.When breathing stops, a listener hears the snoring broken by pauses.With each gasp the sleeper awakens, but so briefly and incompletely, that
he/she usually does not remember doing so.

Because
the etiology of obstructive sleep apnea is multi-factorial and the treatment
options are varied, proper diagnosis and treatment are best handled by a team
approach.The only way a definitive
diagnosis of obstructive sleep apnea can be obtained is by having a sleep study.

Some
of the symptoms of Obstructive Sleep Apnea include:

-
Heavy snoring
- Excessive daytime sleepiness

- High blood pressure

- Morning headaches

- Depression

- Severe anxiety

- Intellectual deterioration

- Temperamental behavior

- Poor job performance

- Dry mouth upon awakening

- Mouth breathing

- Restless sleeps - lot of tossing/ turning

- Difficulty breathing through the nose

- Impotence

Some
of the physical signs of Obstructive Sleep Apnea include:

-
Elongated soft palate
- Poor muscle tone in the soft palate and the back of the throat.

An
increase in OSA is directly related to an increase in weight and age.Men are a little more likely to be affected than women.

Symptoms
of Obstructive Sleep Apnea in children:

-
Snoring
- Hyperactivity (a tired child trying to stay awake)

- Developmental delay

- Poor concentration

- Bed-wetting

- Headaches

- Restless sleeps

- Nightmares

- Night terrors

- Obesity

- Chronic runny nose

- Noisy breathers

- Frequent upper airway infections

What
are the treatments for snoring and OSA?

1)
Miscellaneous treatments - Try weight loss and muscle toning- Sleep on your side rather than on your back (put 3 tennis balls in a
sock and sew it to the back of your pajamas) - Elevate the head of the bed- Avoid smoking - Avoid tranquilizers, sleeping pills or antihistamines
before going to bed - Avoid alcohol within 3 hours of bedtime - Avoid heavy
meals within 5 hours of going to bed.Going
to bed exhausted also increases the chance of snoring.

2)
Continuous Nasal Airway Pressure - CPAP.The
individual wears a mask over the nose while sleeping.Air under pressure is forced past the obstruction in the airway.

3)
Surgery - Some of the nasal passage, throat, or tongue, may have to be removed.Sometimes the jaw or tongue may need to be advanced, or the hyoid bone
raised.

4) Oral Appliances - The appliances are designed mainly
to advance the jaw or tongue while the individual sleeps.The appliances are much like those worn after orthodontic appliances
(braces) are removed.

What
should you do if you think you have Obstructive Sleep Apnea?

First,
discuss your signs and symptoms with your primary care physician.Sleep apnea is a rather new medical specialty, so not all physicians know
as much about it as others.If you
feel you are not getting proper treatment for your condition, see the referral
information below.

If
the physician thinks you may have sleep apnea, he/she will probably recommend a
sleep study.This involves being
monitored while you are sleeping.If
you have significant sleep apnea, CPAP is usually the first treatment of choice
at this time.If for some reason
the CPAP is not effective, other options are available - either surgery or an
oral appliance.Surgery is
non-reversible.Dental appliances
are a non-invasive, reversible treatment that I believe will become the initial
treatment of choice in the future if CPAP is not effective.PREVENTION DURING CHILDHOOD DAYS IS THE BEST TREATMENT.